title: Evaluation of the vascular architecture of focal liver lesions using micro flow imaging.
abstract: OBJECTIVE
  To identify the vascular architecture of focal liver lesions using micro flow imaging and compare it with characteristics on contrast harmonic imaging during the arterial phase.
  
  
  METHODS
  Micro flow imaging and contrast harmonic imaging were performed in 118 patients with various focal liver lesions: hepatocellular carcinoma (n = 70), metastasis(n = 19), intrahepatic cholangiocarcinoma (n = 3), lymphoma (n = 1), hemangioma (n = 17), and focal nodular hyperplasia (n = 8). The vascular architecture of the lesions on micro flow imaging was evaluated by 2 investigators independently to reveal 6 patterns (types IVI). Enhancement characteristics on contrast harmonic imaging were also evaluated.
  
  
  RESULTS
  Inter-reader agreement for delineating the vascular architecture was higher on contrast harmonic imaging (κ= 0.856) than micro flow imaging (κ= 0.613). On micro flow imaging, the vascular patterns of hepatocellular carcinomas were types I (28.6%), II (65.7%), and III (5.7%). On contrast harmonic imaging, 44 of 70 (62.9%) hepatocellular carcinomas showed chaotic vessels, of which 40 were type II and 4 were type II. The vascular patterns of metastases were types IV (78.9%), I (10.5%), and II (10.5%). Typical rim enhancement was identified in 57.9% of metastases on contrast harmonic imaging, and all were type IV. The vascular patterns of focal nodular hyperplasia were types VI (87.5%) and I (12.5%). Typical spoked wheel arteries were identified on contrast harmonic imaging in 2 focal nodular hyperplasia cases. The vascular patterns of hemangiomas were types V (94.1%) and II (5.9%). Typical peripheral nodular enhancement was identified in 88.2% of hemangiomas on contrast harmonic imaging, and all were type V. The χ(2) test revealed that differences in vascular architecture between the lesions were significant on micro flow imaging (P < .001).
  
  
  CONCLUSIONS
  Micro flow imaging permitted detailed delineation of the vascular architecture of focal liver lesions. Hepatocellular carcinoma, metastasis, focal nodular hyperplasia, and hemangioma showed characteristic vascular architecture.
authors.affiliation: Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Yang
authors.forename: Guang-Jian
authors.initials: GJ
authors.lastname: Liu
authors.forename: Ming-De
authors.initials: MD
authors.lastname: Lu
authors.forename: Hui-Xiong
authors.initials: HX
authors.lastname: Xu
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D044085:Microfluidics / Q000379:methods*; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000150:complications / Q000000981:diagnostic imaging*; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018608:Ultrasonography, Doppler / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: contrast-enhanced sonography; focal liver lesions; micro flow imaging; vascular architecture